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Breaking down silos to advance caregiver and patient outcomes


Efforts to advance healthcare safety culture, workforce engagement, and inclusion are all too often siloed. When leaders fail to recognize the interdisciplinary nature of these domains, the data story quickly narrows, and any ensuing strategies to address performance gaps are limited in their impact. Worse yet, patient outcomes suffer. Healthcare leaders must understand how these elements are intertwined. Only then can they integrate their efforts to create a single, consolidated approach to organization-wide improvement.

But first, defining these terms establishes a solid foundation to build your program upon. Ensure everyone at your healthcare organization shares a common understanding of what “safety culture,” “engagement,” and “inclusion” mean before you can begin breaking down the silos between them.

  • Safety culture: Healthcare workers are held accountable for unprofessional conduct but not punished for human error. Mistakes are identified and mitigated before harm occurs, and systems are in place to help staff learn from missteps and near misses to prevent recurrence.
  • Engagement: Employees forge a strong emotional bond with their organization. They take pride in what they do, speak favorably about their employer, go the extra mile, and proactively “co-own” their engagement (instead of waiting for leaders to initiate).
  • Inclusion: All individuals and groups are treated fairly and feel universally welcomed, respected, supported, and valued.

FIGURE 1: Inclusion & Engagement Are Strongly Related

The critical intersections of safety culture, inclusion, and engagement in healthcare

The data doesn’t lie. Engagement and inclusion are highly and undeniably correlated across all populations (Figure 1). Specifically, higher scores for perceptions of diversity and inclusion are associated with higher levels of engagement, regardless of race or ethnicity. National data also demonstrates that a positive safety culture is strongly correlated to higher performance on both engagement and inclusion (Figures 2 and 3).

Importantly, better safety, quality, and experience outcomes are rooted in a strong safety culture and a highly engaged workforce.

FIGURE 2: Safety Culture Composites Are Strongly Related to Engagement

FIGURE 3: Safety Culture Composites Are Related to Inclusion

The kind of engagement that drives widespread positive outcomes and a focus on continuous improvement hinges on a safe culture and an inclusive environment. Integrating efforts into a single, consolidated approach helps accelerate improvements across safety, engagement, and inclusion. Since these areas are historically “owned” and led by different teams and functions—safety, HR, and diversity, equity, and inclusion (DEI), respectively—breaking down the silos between them is essential to achieve positive results. For example, dismantling hierarchies, promoting teamwork, and encouraging staff to speak up are all endeavors that nurture these three domains simultaneously.

Healthcare leaders can proactively implement many strategies and tactics to drive an organizational culture of safety improvement and positive safety culture. These include:

  • Setting a goal of zero harm
  • Messaging on safety, with an emphasis on "speaking up" for safety concerns, addressing each safety event head-on, and reducing patient harm
  • Making harm visible across the organization to all healthcare workers and leaders
  • Conducting daily safety huddles

3 ways to break down silos at your organization

This important work can’t be done in a vacuum. To begin your journey toward a safer, more equitable workforce environment, convene with leaders across departments and consider the following three steps.

  1. Create multidisciplinary groups to advance efforts on safety culture, engagement, and inclusion. Aligning and rallying behind the same mission is the first step. Setting up multidisciplinary teams must be a deliberate effort on the part of leaders, not an ad hoc innovation.
  2. Use integrated analytics to understand gaps and identify priorities across safety culture data and engagement data. Organizations need comprehensive performance insights to improve. The correlations highlighted above exist at the unit level—where problems often lie—suggesting robust measurement is needed to get at that level of analysis. Linking safety culture data with caregiver engagement data in a critical metrics map or on PGFusion's Integrated Analytics dashboard, for example, makes it easier to identify and prioritize areas that would benefit from targeted improvement strategies.
  3. Develop cross-cutting interventions using high reliability principles and practices, such as universal skills and leadership behaviors. Leveraging the existing high reliability framework in creating cross-cutting interventions facilitates buy-in and sets staff up for success. When a hospital or other healthcare organization integrates engagement and DEI efforts into familiar safety behaviors, its staff members feel they can manage the work involved as well as understand expectations.

>> Case study: Integrating safety culture and DEI to deliver high-quality, compassionate patient care for all

Healthcare workers share a common goal of delivering the best possible outcomes while reducing patient harm and caregiver suffering at all costs. But siloed departments can hinder these efforts, causing disconnects that compound at the sharp end of care.

Healthcare leaders must address the emotional harm caused by implicit bias, microaggression, and incivility just as they seek to minimize any physical injury, safety issue, or medical error. Early detection and intervention are key to avoiding an adverse event. On a wider scale, leaders must acknowledge—in word and action—the inherent connections between safety culture and safety improvement, workforce engagement, and inclusion to drive measurable, purposeful improvements across the board.

To learn more about how Press Ganey is breaking silos and improving the safety climate across the healthcare industry, check out our latest leading industry programs: Safety 2025: Accelerate to Zero and the Press Ganey Equity Partnership.

For help conducting a safety culture assessment at your hospital or healthcare institution, or to learn more about the Press Ganey safety culture survey, get in touch with a Press Ganey expert.


About the author

As Chief Safety and Transformation Officer, Dr. Gandhi, MPH, CPPS is responsible for improving patient and workforce safety, and developing innovative healthcare transformation strategies. She leads the Zero Harm movement and helps healthcare organizations recognize inequity as a type of harm for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing healthcare disparities and the impact of racial inequities on patients and caregivers. Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.

Profile Photo of Dr. Tejal Gandhi, MPH, CPPS